Do physicians in primary care and mental healthcare professionals in America treat marginalized patients holistically? A literature review.

Talk Code: 
Angel Bierce
Author institutions: 
University of Texas at Austin, University of Bristol


Physicians in primary care need to look holistically at patients’ lives and community to efficiently treat transgenerational transmission of trauma (TTT), which is often not considered in diagnosis and treatment plans. TTT is the theory that trauma can be transferred from the first generation of trauma survivors to their offspring and onward to further generations. Evidence suggests that both prenatal and in utero stressors can influence the offspring’s ability to respond to stress and their susceptibility to PTSD through miRNA, hippocampus size, and cortisol levels. Also, a lineage that has generations compound? stressed (like many minority groups) can have these effects at a greater magnitude. One aspect that the literature has addressed is that it’s not always a grand catastrophe that can cause the occurrence of these epigenetics. Stressors could be a result of abuse, food insecurity, lack of financial stability, and more ‘every day’ occurrences. Since these stressors happen more often itis important that mental healthcare and primary care providers find treatment for ‘common’ people, rather than focusing on cisgendered, heterosexual white men. The aim of this literature review was to identify evidence-base on how TTT and lesbian, gay, bisexual, transgender, and queer patients are being cared for and identify any discrepancies in primary healthcare regarding treatment of minorities suffering from TTT.


A search was conducted across multiple databases to identify relevant papers to conduct a qualitative study. First, papers relating to transgenerational transmission of trauma were reviewed to establish a working definition and understand circumstances in which it occurs. Then, papers investigating natural disasters and race were reviewed to compare how different races were impacted, and how primary care, or lack of, influenced the road to recovery. Lastly, a search for possible resources for marginalized communities was conducted and came up short due to there being an insufficient supply; One CBT manual for “therapy across cultures” and one LGBTQ+ manual related to conversion therapy. A chapter in one book is simply not enough to cover the differences in cultures, somatic symptoms, and the complexities of others’ lives.


Findings focused on the social differences, as well as lack of primary care received by ethnic minorities and members of the queer community. The literature review found that there was a lack of treatment and resources in primary care and cognitive behavioral therapy manuals to treat marginalized groups suffering from TTT.


Moving forward, it is important to examine race, sexual orientation, and identity as a factor in primary and mental healthcare to improve treatment of marginalized people. This review contributes to a better understanding of what TTT is and identify potential issues in primary mental healthcare treatment when the individual is not viewed and treated holistically.

Submitted by: 
Angel Bierce
Funding acknowledgement: